Vicini Rino, Brügger Dominik, Grabe Hilary, Abegg Mathias
Department of Ophthalmology, Zurich University Hospital, Zurich, Switzerland.
Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland.
Klin Monbl Augenheilkd. 2025 Apr;242(4):485-488. doi: 10.1055/a-2466-0284. Epub 2024 Dec 18.
Current clinical measurements of strabismus angles (SAs) are manual and require a skilled examiner and active cooperation by patients. This results in high interexaminer variability, and clinical use is limited by the availability of trained examiners. An objective and automated procedure, independent of the examiner, would be useful. This single-center, prospective, diagnostic feasibility study compared the vertical and horizontal SA of patients, as measured with a commercially available virtual reality headset (VRH) and custom software with the gold standard measurements performed manually with the Harms tangent screen (HW) and the alternate prism cover test (ACT). We implemented the ACT by showing the patient a fixation target on each eye alternatively with the VRH while recording the eye position of the patient. We then processed the data with custom written software to calculate the SA of the patients. These measurements were then compared to the SA measured with HW and the clinical ACT. Thirty-three patients took part in our study. We found good correlation between the VRH method and the HW as well as the clinical ACT. Best correlation was found for horizontal SA in the primary position, with the vertical SA in the primary position also correlating well. Peripheral gaze resulted in a slightly lower correlation due to the overestimation of horizontal SA and underestimation of vertical SA; cyclorotation was not measured with the VRH. Overall, VRH, HW, and clinical ACT correlated similarly well as the published interexaminer correlation for ACT. The automated measurement of strabismus with a VRH is feasible, easily applicable, fast, accurate, and can be run on consumer hardware that is affordable and increasingly available.
目前斜视角度（SAs）的临床测量是手动的，需要熟练的检查者以及患者的积极配合。这导致检查者之间的变异性很高，并且临床应用受到训练有素的检查者可用性的限制。一种独立于检查者的客观且自动化的程序将很有用。这项单中心、前瞻性、诊断可行性研究比较了使用市售虚拟现实头戴设备（VRH）和定制软件测量的患者垂直和水平斜视角度，以及使用哈姆斯正切屏（HW）和交替棱镜遮盖试验（ACT）手动进行的金标准测量。我们通过使用VRH向患者交替展示每只眼睛上的注视目标来实施ACT，同时记录患者的眼睛位置。然后我们使用定制编写的软件处理数据以计算患者的斜视角度。然后将这些测量结果与使用HW和临床ACT测量的斜视角度进行比较。33名患者参与了我们的研究。我们发现VRH方法与HW以及临床ACT之间具有良好的相关性。在第一眼位水平斜视角度的相关性最佳，第一眼位垂直斜视角度的相关性也很好。周边注视导致相关性略低，这是由于水平斜视角度高估和垂直斜视角度低估所致；VRH未测量旋转斜视。总体而言，VRH、HW和临床ACT的相关性与已发表的ACT检查者间相关性相似。使用VRH自动测量斜视是可行的，易于应用，快速，准确，并且可以在价格实惠且越来越容易获得的消费级硬件上运行。
